CHAPTER 3
Key outcomes for people who use services
We define outcomes as the direct benefits in people's lives of the social work services they receive.
The social work service performed to a good standard in providing positive outcomes for people who use services, showing important strengths with some areas for improvement.
People who use services
As part of this inspection, we surveyed people who use services in Highland. Most respondents agreed social work services had helped them to feel safer. Most agreed that services had helped them lead a more independent life and had helped them to feel part of the community.
During fieldwork, we observed practice, met a wide range of people who used services and found evidence of improvements in people's lives as a result of social work interventions. For example, we met an older person with mental health problems who had been enabled to return home from hospital to live in their own home. A supportive package of care was provided despite the complications of a remote rural setting, accommodation difficulties and the complex needs of the service user. We also met a man with learning disabilities who had been a long stay patient in Craig Phadrig hospital. He was being supported to live in a shared tenancy, had a varied social life and employment opportunities.
Partners and stakeholders
We also asked key partners and stakeholders, including voluntary sector and other Council services for their views. Less than half of the 21 organisations who responded agreed overall that the social work service provided good outcomes for people who use services and their carers. Less than half of the 20 who responded agreed that overall the social work service was well organised to improve services and outcomes for people who use services and their carers. And less than half of the 20 respondents agreed that overall people who use services and their carers value services and find them a positive experience.
Measuring outcomes
We read a sample of 100 case files, 60 adults' files and 40 children's files. There was evidence of positive outcomes for service users which were being tracked at case level. In almost all of the files where there was a response there was evidence that the objectives set out in the care plan were met. In most of the files, where there was a response, the individual had been helped to access mainstream services. In the majority of files read the individual's circumstances had improved during the period under review.
Case files were largely hand written. Information recorded electronically was limited. Although individual service user outcomes were being recorded on their files there was no system for collating this information. Less than half of children's files read, and few adult files, had evidence that a first line manager regularly scrutinised them. The social work service was in the process of replacing the SSIDIT system with CareFirst, which was due to go live in April 2007.
Outcomes for children and families who use services
Integrated children's services
The overarching objective of the integrated children's services plan 'For Highland's Children' was to achieve better outcomes for all children and families. Partners recognised that to achieve this everyone involved with children and young people needs to work together. Integrated children's services in Highland followed the national framework provided in 'For Scotland's Children'. There were fifty locally agreed key outcome targets in the integrated children's services plan 'For Highland's Children 2'. It was a comprehensive plan, covering universal service provision for children and families, as well as targeted services like social work. As a result, not all the fifty outcome targets related directly to the social work service. The plan outlined an integrated strategy to improve outcomes by ensuring that children and young people got the support that was determined by their needs, when they needed it. This was delivered through 'tiers' of intervention from universal provision, early intervention, targeted and finally specialist services.
An evaluation of integrated community schools in Highland 2 had been carried out by the University of the Highlands and Islands. This comprised two surveys which covered both process and outcome factors. Three quarters agreed that integrated working had had a positive impact on children with special needs and disabilities and on children who were at risk of being excluded from school. Around two thirds felt it had also had a positive impact on looked after children and those at risk of harm.
Good practice example
A 6-year-old boy, placed with prospective adoptive parents, was behaving aggressively at school. Other parents complained to the school and to the local elected member. Using the school liaison group the social worker, senior social worker, educational psychologist, school staff and prospective adopters took a solution focused approach. The principal educational psychologist, adoption senior social worker and the elected member held an information meeting for parents to engage and 'educate' the community. School staff attended an adoption UK workshop. As a result of all those involved working together creatively, he was successfully supported and remained at school.
Youth justice
Youth justice services in Highland were delivered by a number of agencies under the umbrella of the 'Youth Action Service'. The agencies involved included the social work youth action teams, Northern Constabulary, children's reporter, NCH, Blast, Apex, SACRO and Positive Parenting Scotland. The Youth Action Service aimed to provide services to young people offending or misusing drugs and alcohol.
Highland was one of seven authorities to achieve the Scottish Executive's target of at least a 10% reduction of the number of children and young people identified as persistent young offenders (by March 2006). 3
During fieldwork we were able to meet staff who worked in the Youth Action Service. We were also able to observe practice. It was clear that a wide range of approaches were being taken to work with young people who were offending or who were at risk of offending.
We spoke to parents participating in parenting groups who were very positive about the difference it was making to their relationships with their children. They talked of feeling more confident as parents and also less isolated. We heard that immediate outcomes were measured by questionnaires at the beginning and end of the course.
Good practice example
'Positive Parenting', a UK-wide voluntary organisation, was employed to run parenting groups for the Youth Action Team. Eight courses are run every year throughout Highland. Each lasted around 8-10 weeks. We observed one such course at 'The Bridge', Inverness. All the parents said they were finding the course rewarding. They were grateful for the opportunity to talk to each other about their difficulties. The group made them realise they were not alone and they learned from each others' experiences.
Reports (time intervals)
The Scottish Executive has set targets for the submission of reports to the children's reporter. It is recognised that late reports can impact negatively on outcomes for children and young people by delaying key decisions in their lives.
Statistics from 2005/2006 show that only 37% of reports were submitted within the required time. 4 This was similar to the Scottish average of 36%. Figures released recently did show an improvement, with 50%, in the last quarter, being submitted on time. 5 We note that there had been continued improvement since the inspection.
Child protection
Scottish Executive statistics for 2005/06 show that on the 31 March 2006 there were 110 children's names on the child protection register in Highland. This represented 2.8 per 1,000 population aged under 16 years, and was similar to a Scottish rate of 2.5. 6
HMIe carried out a pilot inspection of services to protect children and young people in Highland in 2005. They found that overall children and young people were well protected but their needs were not always effectively met.
Looked after children
The proportion of children in Highland who were looked after was 1% of the 0-18 population. This was similar to the national average of 1.2%. A proportion of 35% were known to have a disability, higher than the Scottish average of 11%. 7
A proportion of 88% of looked after children were living in community settings, including those who were looked after at home, which was around the national average. This was an improvement on previous years. 8
Providing stability is key to achieving positive outcomes for children. Of children and young people who were looked after away from home, only 8% had three or more placements. This is much better than the national average of 29%. 9
Educational attainment
There are national outcome targets to improve educational attainment of young people looked after by local authorities.
In 2005, 58% of those sixteen and seventeen year olds leaving care in Highland had qualifications in English and Maths. A proportion of 67% had at least one qualification (at SCQF 3 or above). This was higher than the Scottish averages of 39% and 55% respectively. 10 We note that there had been continued improvement since the inspection.
Those young people ceasing to be looked after at home did not perform quite as well with 27% of them gaining similar qualifications although this compared favourably with a Scottish average of 22%.
Highland had two School Link Workers who liaised with schools to improve the educational outcomes of looked after children and young people. They worked both with children and young people who were looked after at home, and those looked after away from home. They linked with schools, tuition services and alternative education services. Their aim was to help looked after children and young people secure and sustain full time education.
They did not have any role with children and young people who were placed outwith Highland. This was being reviewed.
During the fieldwork phase of the inspection we were concerned to hear about a number of young people who were not accessing mainstream education. Although they were receiving tutoring, in one case this amounted to just 20 minutes a week.
Recommendation 1
The Highland Council should review arrangements to ensure that all looked after children are supported to access to education services, including mainstream education where appropriate.
Health
Highland had a 'Looked after health co-ordinator'. This post had been in existence for almost three years. She was the only LAC nurse in Highland so she liaised with local professionals to ensure they took on responsibilities for looked after children.
The effectiveness of this post was demonstrated by the steady increase over the past three years in the percentage of children looked after in foster homes with appropriately reviewed health plans. All children and young people in residential units now had appropriately reviewed health plans. A database had been set up to log these assessments.
The 'Looked after health co-ordinator' had also negotiated quicker access to CAMHS for looked after children. Every child who was looked after was able to have a mental health assessment.
Through care and aftercare
Local authorities, as corporate parents, have a duty to prepare young people for leaving care and to support and advise those who have moved on to independence.
The Highland Council funded Barnardo's Scotland to provide a specialist through care and aftercare service for young people. Barnardo's Springboard had both the strategic responsibility for the development of through care and aftercare services and for the provision of services to individual young people.
We spoke to a group of young people using the Springboard service. They all felt that their support workers had been helpful. They said their accommodation was their greatest problem. There had been few choices available to them and some were living in bed and breakfast accommodation. Their access to education or training was also very limited.
Figures for 2005/2006 show that only 17% of young people entitled to aftercare support were known to be in employment, education and training. This was less than the Scottish average of 23%. 11
To help looked after young people make a successful transition to independent adult living, local authorities have a duty to provide a full assessment of their needs and a 'Pathway' plan. This was introduced in 2004. Of the 43 young people (aged 15-18 years) leaving care in Highland in 2005, none had a pathway plan and just 37% had a pathway co-ordinator. 12 We note that there had been significant improvement in performance since the inspection. We have commented further on the service's performance on transitions for young people in Chapter 5.
Outcomes for adults and older people who use services
Adults with learning disabilities
Figures provided to the Scottish Executive for 2005 showed that more than half of adults with learning disabilities in Highland had a personal life plan. This compared to only a quarter nationally. With regard to facilitating employment and training opportunities, Highland was performing well. A proportion of 40% were in employment compared to only 14% nationally. Significantly, 66% of those in employment were in open employment. A proportion of 17% were in further education which is the national average. A proportion of 11% were participating in training opportunities against a Scottish average of 7%, and 19% were accessing community short breaks against a national average of 11%. 13
After some significant delay, the de-commissioning of New Craigs is to be completed by March 2008. An assessment and treatment centre with six in-patient beds will be retained on the site.
However, there were no local area co-ordinators in Highland. We understood that the social work service is working with NHS Highland and 'Health and Happiness' to establish local area co-ordination.
Older people
In its Joint Performance and Assessment Framework ( JPIAF) evaluation statement 2005/06, the Scottish Executive noted the overall 'steady progress' of Highland's performance. This evaluation recognised the Highland community care partnership had continued to deliver positive results on delayed discharges and admissions.
This outcome does not sufficiently explain the situation in Highland however. We found that a significant proportion of older people were being discharged into care homes rather than to their own homes or more suitable accommodation in the community. Overall the balance of care was still too dependent on care homes.
In 2005 around 46 per thousand people aged 65 and over lived in care homes, as compared with 40 in Scotland overall, and 36 in comparator authorities.
Home care
In 2005, in Highland, around 62 people per thousand of the over 65 population were receiving home care. This is similar to the rate in comparator authorities, but less than the Scottish average of nearly 70. 14
Providing home care in the evenings and at weekends is key to enabling people to live in their own homes as independently as possible. The social work service recognised that it must increase its provision of home care during these times. However, recent figures showed a decrease in both the number of people receiving a service and the total number of hours purchased by Highland. 15
During our fieldwork phase we were able to observe home care which was enabling people to remain in their own homes despite their complex needs. We also heard that choice was limited to home care service users in terms of times of availability. Lack of flexible home care was preventing people from remaining in their own homes. Home care services were poorly developed across Highland. We comment further on this issue, and make a recommendation, in Chapter 6.
Direct payments
Direct payments allow people to purchase and manage, for themselves, some, or all of the care they need. They are one way of increasing the choice, flexibility and control people have over their care. They can help people live more independently in their communities.
Over the last five years the number of people using direct payments in Highland has been increasing. In 2005/2006, 194 people accessed direct payments to purchase services to the value of £1,212,000. Highland performed well in national terms regarding the take up of direct payments. The rate in Highland in 2005/2006 was 9.1 per 10,000 population compared to a Scottish average of 3.6. 16
We heard from elected members that more people were being encouraged to look at direct payments. This was because they recognised that the best services were built around direct payments. They also acknowledged that they had to do more to support people to get direct payments.
Highland employed a Direct Payments Support Officer to provide help and advice to staff and service users. There is a detailed guide to the Highland Direct Payments Scheme for staff. This was a useful document but was still in draft form.
When we met with groups of service users and carers we found many were unsure of how to go about accessing direct payments. Some users told us they would like the freedom of using direct payments and they had been offered them. Some users and carers told us they were put off applying as they did not think they would get enough support to administer direct payments. We would encourage the social work service to ensure that people are informed fully about direct payments and appropriately supported to make use of them.
Carers
Many older people and people with disabilities are only able to remain living in their own homes because of the many hours of voluntary care they receive from relatives or friends.
There were a number of active carers groups and organisations in Highland.
Our carers survey was largely distributed through local carers organisations. We had a response rate of one in five. Carers who responded to our survey generally did not see the social work service as providing good outcomes for the person they cared for.
Less than half agreed the services:
- resulted in an improved quality of life for the person they cared for
- helped the person they cared for to feel safer
- had helped the person they cared for lead a more independent life
- had helped the person they cared for feel part of their community.
We make further comment on issues for carers in Chapters 4 and 5, and a recommendation in Chapter 6.